'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Lansley defends private sector plans

Health secretary Andrew Lansley has accused Labour of stoking up fears over the threat to the NHS posed by private providers, despite having itself paved the way for a massive increase in their involvement in the NHS.

The health bill passed its second reading by 321 votes to 235 in the Commons yesterday, with the Government accused by the opposition of paving the way for the destruction of the health service with its controversial policy of 'any willing provider'.

Mr Lansley, who faced renewed attacks for receiving a campaign donation from the wife of the then chair of private provider, Care UK, in the run up to the election, said the Government had learnt from the failures of fundholding and Labour's ‘piecemeal' efforts to open the NHS to market forces to settle on a formula that would lead to a modernised NHS and improved health outcomes at a time of financial crisis.

‘We have made no estimate of the extent to which GP-led commissioning consortia will contract with independent sector providers,' he said.

‘Under the previous Conservative Government, the internal market and fund holding of the early 1990s failed to promote quality and risked conflicts of interest among GPs.

‘We have learned from those mistakes and from the failings of a Labour Government over the past 13 years.'

He added: ‘The idea that somehow general practice-led commissioning consortia would engage the private sector where that has not happened up until now is, I am afraid, completely contradicted by the facts. Under the Labour Government, in the two years leading up to the election, there was an 80% increase in the use of management consultants, while at the same time the number of administrators and managers in those same organisations was rising dramatically.

'We arrived at the point where there were 50,000 administrators in primary care trusts, and they were still spending nearly £300 million a year on top for management consultancy.'

Mr Lansley also faced attacks over an alleged broken promise not to introduce a top-down re-organisation of the NHS, stressing that the expertise of thousands of PCT managers would be retained.

‘We set out very clearly our estimates - they are no more than estimates since they will have to be decided by the GP commissioning consortia and local authorities - that between 50% and 70% of the staff in primary care trusts would be employed in the successor organisations,' he said.

The health secretary also claimed the results of an RCGP poll, showing six out of 10 GPs were against his plans, were not born out by GPs on the ground, claiming opposition from the likes of the BMA and the college ‘contrasts completely with the reaction of GPs and health care professionals in GP pathfinders.'

John Healey, shadow health spokesman, denied the coalition plans were an extension of previous Labour policies.

He said: ‘It is true that we encouraged many of the GP commissioning models that the Health Secretary now champions, but that process was always within a planned and managed system, and it was never implemented at the expense of other clinicians or patients being in charge. We used private providers when they could add something to the NHS and help it to raise its game.'

David Lammy, Labour MP for Tottenham, Labour, attacked Mr Lansley's, asking why ‘the Secretary of State, in response to my question earlier, did not confirm to the House that the wife of John Nash, the chairman of Care UK, funded his office in November 2009 to the tune of £21,000?'

Mr Lansley also came under fire from Liberal Democrat MP Andrew George, from St Ives, who claimed GPs were becoming pathfinders 'more out of resignation than enthusiasm for solely GP-led clinical involvement in commissioning.'

However, the first stage of the bill ended in a comfortable victory for the coalition.

A spokperson for Care UK later said the donation to Mr Lansley's office was 'a personal donation from Mrs Nash, not Care UK,' and added that Mr Nash stepped down as its chair in the spring of last year.

'Despite press reports, he is not working for us as a consultant,' she said.